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European Journal of Echocardiography Advance Access originally published online on July 1, 2009
European Journal of Echocardiography 2009 10(8):975-978; doi:10.1093/ejechocard/jep092
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Echocardiographic assessment of a cardiac lymphoma: beyond two-dimensional imaging

António Gaspar1,*, Nuno Salomé1, Sérgio Nabais1, Aida Brandão1, Alda Simões1, Catarina Portela2, Alberto Salgado1, António Pereira1 and Adelino Correia1

1 Department of Cardiology, Hospital de S. Marcos, Apartade 2242, 4701-965, Braga, Portugal
2 Department of Oncology, Hospital de S. Marcos, Braga, Portugal

Received 11 March 2009; accepted after revision 6 June 2009; online publish-ahead-of-print 1 July 2009.

* Corresponding author. Tel: +351 915301131; fax: +351 253209091.E-mail address: antoniog80{at}portugalmail.com


  Abstract

Lymphoma is usually recognized as the third most frequent metastatic malignancy involving the heart. In recent years, the incidence of cardiac lymphoma has increased, mainly because of HIV-infected patients. We present a case of secondary cardiac lymphoma in an HIV patient presenting with heart failure. Transthoracic echocardiography showed increased left ventricular (LV) wall thickness and an extensive mass in the right cavities with involvement of the tricuspid annulus (Figure 1). Doppler tissue imaging (DTI) showed reduced systolic and diastolic velocities at mitral and tricuspid annulus, compatible with systolic and diastolic myocardial dysfunction, likely owing to infiltration. After 2 weeks of chemotherapy, repeated exam showed significant reduction of the tumour mass and of the LV wall thickness, as well as normalized systolic and diastolic velocities at mitral and tricuspid annulus, as assessed by DTI. Use of transthoracic echocardiography, mostly two-dimensional imaging, has been described for several years for the diagnosis of cardiac involvement as well as for the assessment of tumour regression in response to chemotherapy. The present case report highlights the potential utility of other echocardiographic modalities, particularly DTI, for the assessment of cardiac lymphoma but also for monitoring the tumour response to adequate therapy.

Keywords: Cardiac lymphoma; Infiltration; Transthoracic echocardiography; Doppler tissue imaging


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